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Colleagues,

As reported by Aunt Minnie ... In the midst of a massive governmental healthcare reform effort in the U.S., medical imaging is being squeezed. And it's not just Congress exerting the pressure: It's also an alphabet soup of government agencies with a plethora of proposals for cutting imaging payments.

... To get a better lay of the land, AuntMinnie.com has put together a primer on the outstanding issues for radiology going forward into 2010...

Healthcare reform and the SGR

Congress mandated the sustainable growth rate (SGR) as a means of limiting healthcare expenditures by creating a formula for setting physician payment rates in the Medicare Physician Fee Schedule (MPFS) to the gross domestic product. When actual healthcare spending exceeds the estimate for that year, Medicare uses the SGR formula to reduce physician reimbursement for the following year to break even.

While it sounds like a great idea, healthcare industry observers believe that the formula used to develop the SGR is flawed, and Congress each year typically passes legislation to postpone the annual cuts. Because Congress has kicked the problem down the road every year rather than find a permanent solution, the SGR formula now calls for a whopping 21% cut in the SGR's conversion factor, which industry advocates have been fighting to mitigate.

On December 22, President Barack Obama did just that by signing the Department of Defense Appropriations Act, which was advocated by the American Medical Association and included a provision that postponed the SGR cut until March 1, 2010...

... To make things more complicated, if a more permanent fix for the broken SGR formula isn't found and implemented by March 1, CMS will have to again recalculate its fee schedules, this time with the 21.2% cut...


Congress, CMS, equipment use and body parts

In its final rule for new MPFS rates published last fall, the CMS imposed steep cuts to radiology payments. For example, the total cut for MRI is between 40% and 50% in the technical component of imaging exams... Since the change is so dramatic, CMS is transitioning it in over four years, so physician practices won't feel the full effect until 2013...


PPIS: Practice expense nightmare

Another confounding factor in the MPFS cuts are changes CMS has set for practice expenses. The American Medical Association (AMA) conducted the Physician Practice Information Survey (PPIS) to update indirect practice cost data for its Socioeconomic Monitoring Survey (SMS), the last of which was performed in 1999. (Indirect costs include overhead costs in the technical component and all of the physician expense RVUs in the professional component)...

... The ACR has made numerous comments to CMS about the PPIS, noting that it is not representative of radiology, that its methodology may have hurt specialties with high direct expenses, and that the data collection methods for the survey have not been transparent. ACR suggested that CMS delay the implementation of any changes from the PPIS and use the SMS results in the interim; or, if the PPIS data must be used, blend them with SMS data and transition over four years. CMS agreed to transition over four years...


A funny thing happened on the way to the MPFS

On top of this, CMS has instituted at least 30 new radiology-related CPT codes for 2010, including three for CT colonography; four for coronary CT and CTA; one for cardiac MR with flow, and four bundled myocardial perfusion with wall motion and ejection fraction codes ...

... In particular, the bundled myocardial perfusion codes have unintended consequences: There's physician work and practice expense value loss when these codes are bundled, and since CMS sees them as new codes, they take the full brunt of the final rule cuts, fully transitioned at 2013 values. ACR is working to communicate to CMS that these codes should not be considered new ...

Complex, but true ...

Read on at: http://www.auntminnie.com/index.asp?Sec=sup&Sub=imc&Pag=dis...

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